Revisión sobre aspectos bioéticos en las decisiones de triaje en la Unidad de Cuidados Intensivos durante la pandemia por COVID-19

Introducció: La pandèmia per COVID-19 va provocar un augment en els pacients canalitzats a les Unitats de Cures Intensives (UCI). L'aplicació d'algoritmes de triatge va provocar dilemes ètics quan calia decidir sobre el maneig clínic i/o el tractament dels pacients. Objectius: Analitzar els principals aspectes bioètics involucrats en els algorismes usats en la presa de decisions de triatge a l'UCI durant la pandèmia per COVID-19 a partir d'una revisió de la literatura publicada en el període comprès des del juliol de l'any 2020 fins al febrer del any 2021. Mètodes: Es va realitzar una cerca a Pubmed, SciELO, Ovid i Cochrane amb els termes de cerca en anglès i espanyol: “triage” (triatge), “Covid”, “SARS Cov-2”, “unitat de cures intensiva”, “ ètica”. S'exclogueren els articles que no esmentaren algoritmes d'intervenció a l'UCI, que no analitzen la presa de decisions, que no impliquen l'entorn clínic, que no estiguessin indexats o articles repetits. Resultats: Es van obtenir 45 articles: els resums van ser revisats de forma independent per dos autors per eliminar biaixos, seleccionant 12 articles que complien els criteris de selecció. Es va trobar que els principals aspectes ètics que es van tenir en compte van ser: priorització inevitable, justícia i suport al rol del judici clínic tenint en compte els drets personals. Conclusions: Cal fer ajustaments bioètics per estandarditzar la universalització de la presa de decisions en moments on la capacitat dels serveis de salut es veu excedida.Introduction: The COVID-19 pandemic caused an increase in patients referred to Intensive Care Units (ICU). The application of triage algorithms caused ethical dilemmas when it was necessary to decide on the clinical management and/or treatment of patients. Objectives: To analyze the main bioethical aspects involved in the algorithms used in triage decision-making in the ICU during the COVID-19 pandemic based on a review of the literature published in the period comprehended from July 2020 to February 2021. Methods: A search was conducted in Pubmed, Scielo, Ovid and Cochrane with the search terms in English and Spanish: “triage,” “Covid,” “SARS Cov-2”, “intensive care unit”, “ethics”. Articles that did not mention intervention algorithms in the ICU, which do not analyze decision-making, which do not involve the clinical setting, which were not indexed, or repeated articles were excluded. Results: 45 articles were obtained: Two authors independently reviewed the abstracts to eliminate bias, selecting 12 articles that met the selection criteria. It was found that the main ethical aspects that were considered were: unavoidable prioritization, justice, and support for the role of clinical judgment, taking personal rights into account. Conclusions: It is necessary to make bioethical adjustments to standardize the universalization of decision-making at times when the capacity of health services is exceeded.Introducción: La pandemia por COVID-19 provocó un aumento en los pacientes canalizados a las Unidades de Cuidados Intensivos (UCI). La aplicación de algoritmos de triaje provocó dilemas éticos cuando se tenía que decidir sobre el manejo clínico y/o el tratamiento de los pacientes. Objetivos: Analizar los principales aspectos bioéticos involucrados en los algoritmos usados en la toma de decisiones de triaje en la UCI durante la pandemia por COVID-19 a partir de una revisión de la literatura publicada en el periodo comprendido desde julio del año 2020 hasta febrero del año 2021. Métodos:  Se realizó una búsqueda en Pubmed, SciELO, Ovid y Cochrane con los términos de búsqueda en inglés y español: “triage” (triaje), “Covid”, “SARS Cov-2”, “unidad de cuidados intensivo”, “ética”. Se excluyeron los artículos que no mencionaron algoritmos de intervención en la UCI, que no analizan la toma de decisiones, que no implican el entorno clínico, que no estuvieran indexados o artículos repetidos. Resultados: Se obtuvieron 45 artículos: los resúmenes fueron revisados de forma independiente por dos autores para eliminar sesgos, seleccionando 12 artículos que cumplían con los criterios de selección. Se encontró que los principales aspectos éticos que se tomaron en cuenta fueron: priorización inevitable, justicia y apoyo al rol del juicio clínico tomando en cuenta los derechos personales. Conclusiones: Es necesario realizar ajustes bioéticos para estandarizar la universalización de la toma de decisiones en momentos donde la capacidad de los servicios de salud se ve rebasada

Selenium serum levels in patients with SARS-CoV-2 infection: a systematic review and meta-analysis

The nutritional status is a determinant of the immune response that promotes a cellular homeostasis. In particular, adequate selenium levels lead to a better antioxidant and immune response. The aim of this work is to assess whether blood selenium levels, at time of SARS-CoV-2 infection, have an impact on the development and severity of COVID-19. A systematic review and meta-analysis of comparative and descriptive studies using MeSH terms, selenium and COVID-19 was performed. We searched bibliographic databases up to 17 July 2022 in PubMed and ScienceDirect. Studies that reported data on blood selenium levels were considered. A total of 629 articles were examined by abstract and title, of which 595 abstracts were read, of which 38 were included in the systematic review and 11 in the meta-analysis. Meta-analysis was conducted to mean difference (MD) with a 95 % confidence interval (CI), and heterogeneity was tested by I2 with random factors with a MD between selenium levels, mortality, morbidity and healthy subjects with a P-value of 0⋅05. Selenium levels were higher in healthy people compared to those in patients with COVID-19 disease (six studies, random effects MD: test for overall effect Z = 3⋅28 (P = 0⋅001), 97 % CI 28⋅36 (11⋅41–45⋅31), P < 0⋅00001), but without difference when compared with the degree of severity in mild, moderate or severe cases. In conclusion, the patients with active SARS-CoV-2 infection had lower selenium levels than the healthy population. More studies are needed to evaluate its impact on clinical severity through randomised clinical trials

Developing an international standard set of patient-reported outcome measures for psychotic disorders

Objective: The objective of this project was to develop a set of patient-reported outcome measures for adolescents and adults who meet criteria for a psychotic disorder. Methods: A research team and an international consensus working group, including service users, clinicians, and researchers, worked together in an iterative process by using a modified Delphi consensus technique that included videoconferencing calls, online surveys, and focus groups. The research team conducted systematic literature searches to identify outcomes, outcome measures, and risk adjustment factors. After identifying outcomes important to service users, the consensus working group selected outcome measures, risk adjustment factors, and the final set of outcome measures. International stakeholder groups consisting of >100 professionals and service users reviewed and commented on the final set. Results: The consensus working group identified four outcome domains: symptoms, recovery, functioning, and treatment. The domains encompassed 14 outcomes of importance to service users. The research team identified 131 measures from the literature. The consensus working group selected nine measures in an outcome set that takes approximately 35 minutes to complete. Conclusions: A set of patient-reported outcome measures for use in routine clinical practice was identified. The set is free to service users, is available in at least two languages, and reflects outcomes important to users. Clinicians can use the set to improve clinical decision making, and administrators and researchers can use it to learn from comparing program outcomes